Healthcare Provider Details

I. General information

NPI: 1144675364
Provider Name (Legal Business Name): DIANA MILAGROS TORPOCO RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date: 12/21/2016
Reactivation Date: 01/19/2017

III. Provider practice location address

3901 BEAUBIEN BLVD
DETROIT MI
48201
US

IV. Provider business mailing address

3901 BEAUBIEN BLVD
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-1892
  • Fax: 313-993-7118
Mailing address:
  • Phone: 313-745-1892
  • Fax: 313-993-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301117226
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: